Testicular Spasms

My son is a healthy 13 year old boy. Ten days ago he was helping to lift a hot water tank. In doing so, he felt a "pull" in the groin area. The next morning, the pain was severe. Our Pediatrician sent him for an ultra sound. The ultrasound determined that there was blood flow, but there was inflamation (inflammation), possibly due to a de-torsion of his right testicle. We then went to a urologist who prescribed 6oo mg. of Ibuprofen, Bactrim and Loratab for the pain. By that evening my son's pain had escalated. The urologist admitted him to the hospital and began to administer IV anti-inflamants, pain meds and antibiotic. The ultrasound was repeated. Still negative. The testicles respond to the test on the inside of the leg and both move. After three days in the hospital, the pain is still excrutiating and doesn't respond to paid meds. A CT was performed and the result was negative. A change in meds was done to include a one time steroid dose. No change. He then underwent a nerve-block. Temporary relief for approximately 12 hours and then right back to where we are. We even took him to Children's Hospital in Pittsburgh where they diagnosed it as epididymitis. This was true of our urologist here at home. He has now experienced for the past 7 days, severe spasms in his right testicle. There has never been any swelling. He has been hospitalized for 10 days. The CT, ultrasounds (3) and IVP have all rendered negative. He is scheduled for an open MRI tomorrow. Can you shed any light on what may be causing these horrific spasms. They occur approximately every 10-15 minutes and last for 30 seconds to 2 minutes in length. It's awful to sit and watch him go through these. He is completely worn out from the pain. These spasms have not responded to any type of pain medication, muscle relaxants or anti inflammatories. We have even thought of the possibility of an epididymal cyst, but nothing has shown in any of the scans. His blood work is normal and so is his temperature. Our next step may be Children's Hospital in Philadelphia for a laproscopy. What are your thoughts?
Thank you, Brenda

Tough to say without examination. There has clearly been a pretty thorough workup, including CT scans, ultrasounds, and IVP. MRI is pending. Ultrasound is normally a pretty good test for torsion (sensitivity around 80 percent) - and if has been done 3 times, most cases of torsion would have been caught.

If epididymitis is the current diagnosis, then ensure that the bacteria is sensitive to the antibiotics present.

An epididymal cyst would have been seen on an ultrasound, so the possibility is less likely if the scans were negative.

If everything is negative, then you may want consider a neurology or pain management specialist to help manage the pain while the antibiotics take effect for the epididymitis.

The last resort would be laparoscopy for the diagnosis - which I'm sure would be considered if the symptoms don't improve.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

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